Patient care by VA psychologists in the 1950s and 1960s.

In 1946, the Veterans Administration, now the Department of Veterans Affairs (VA), underwent extensive organizational and professional changes to accommodate the health care needs of veterans returning from World War Two. In addition to an introduction and brief history of these changes, three psychologists who began their careers in the VA in the first years after that reorganization discuss their patient care experiences, both as trainees and as staff psychologists.

The University of Washington Department of Surgery: training surgeons in the Pacific Northwest.

The General Surgery Residency Program at the University of Washington Affiliated Hospitals serves as the sole university training program in the Pacific Northwest, which encompasses a region representing nearly one-fourth of the United States land mass. We value our role to train excellent surgeons for the communities of the Northwest as well as mentor future leaders in academic surgery. The Department strives to stay on the leading edge of surgical education and continually seeks to improve the quality of the training program. We indeed feel fortunate to have the opportunity to train the best and brightest in one of the most exciting and rewarding professions in medicine.

Veterans affairs and academic medical center affiliations: the north Texas experience.

OBJECTIVE: The authors review the more than 30-year history of the academic affiliation between the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas and the Mental Health Service at the Veterans Affairs North Texas Health Care System. METHODS: The authors interviewed individuals involved at various stages in developing this affiliation about decisions and challenges. RESULTS: The academic association has been very successful on the whole, though not consistently so. At this time, a flourishing educational and research program is in place and seems stable. CONCLUSION: It is not clear how generalizable the Dallas experience is. Both sides of this affiliation have overcome obstacles. Persistence and patience have been crucial, especially when one or the other side produced temporarily insurmountable obstacles. It appears that the decision to pursue the recruitment of both researchers and educators to the North Texas Veterans Health Care System from the beginning may have been crucial in developing a fuller academic collaboration.

Memories of three wars: a nurse's story.

This is the personal story of a civilian critical care nurse who has worked for several decades with war casualties. It begins with her memories of the Vietnam era and her reflections on that war. It then describes how the National Naval Medical Center in Bethesda, Maryland, prepared for the Desert Storm War and continues through the current war in Iraq. The article provides a glimpse of a long and meaningful nursing career and expresses the joy and satisfaction of caring for the wounded warriors of today's conflict.

The Nursing Research Committee: the James A. Haley Veterans' Hospital.

Nursing research has been a part of the culture at the James A. Haley Veterans' Hospital for many years. A Nursing Research Committee (NRC) has been an integral part of this success. The emphasis remains on involving the staff nurse in nursing research. By defining clear-cut goals and objectives, leadership of the NRC reaps substantial professional results.

Alcohol and the liver: metabolism of alcohol and its role in hepatic and extrahepatic diseases.

UNLABELLED: Dr. Charles S. Lieber conducted clinical and experimental studies for more than four decades (three at Mount Sinai and the Bronx VA Medical Centers) with emphasis on liver, nutrition and GI pathophysiology. His major contributions include elucidation of the pathogenesis of alcoholic liver disease, by demonstrating the toxic role of alcohol and describing associated metabolic disorders. This was achieved through judicious clinical studies and newly-developed rodent and primate models with the administration of ethanol in liquid diets. The mechanisms of various pathological and metabolic effects of ethanol were clarified, including hyperlipemia (with the rise in HDL), hyperuricemia, the role of acetaldehyde toxicity and alcohol-induced oxidative stress. The latter, including glutathione depletion, was corrected by S-adenosyl-1-methionine given to alcohol-fed baboons; the compound is now being used successfully for the treatment of patients with alcoholic liver disease in Europe. Alcoholic cirrhosis was produced for the first time in nonhuman primates and shown to be fully prevented by polyenylphosphatidylcholine, which is now being tested in a multicenter clinical trial. Lieber also discovered a new (microsomal) pathway of ethanol metabolism, responsible for the tolerance to ethanol and for several clinically important toxic interactions with other drugs (e.g., acetaminophen), anesthetics, industrial solvents, carcinogens, as well as retinol and b-carotene, with narrowing of their therapeutic window. His work defined the role of the stomach in ethanol metabolism, description of corresponding gender differences, cloning (for the first time) of the gene for sigma ADH (a newly-recognized gastric alcohol dehydrogenase isozyme) with its chromosomal localization, and the discovery of the effects of commonly used medications (e.g., H2 blockers and aspirin) on the activities of the enzyme and on blood alcohol levels in social drinkers. Lieber was among the first to use antibiotics for the elimination of gastric bacterial urease and its ammonia production in man, thereby alleviating chronic gastritis and hypoacidity, with attenuation of hepatic encephalopathy in cirrhotics. He promoted early detection and treatment of heavy drinkers before their social or medical disintegration, by defining precirrhotic lesions and markers of alcohol consumption. CONCLUSIONS: The research of Dr. Lieber and his group yielded a better understanding of the pathogenesis of common hepatic, gastric and nutritional disorders, with elucidation and prevention of serious toxic alcohol-drug interactions and the development of methods for early recognition and more effective approaches to prevent and treat liver and gastrointestinal diseases.